Abstract
<title>Abstract</title> <p>Pancreatic steatosis is common in pancreatic cancer, but previous syntheses addressed mainly prevalence and cancer risk rather than tumor behavior after diagnosis. We evaluated whether fatty pancreas is associated with greater dissemination in adults with established pancreatic cancer. Five databases were searched through June 19, 2026 under a registered protocol (PROSPERO CRD420261445124). Observational studies classifying fatty pancreas by imaging or histology were eligible. Lymph node metastasis was the primary outcome and overall survival the secondary outcome. Estimates were pooled with random-effects models; risk of bias was assessed with Quality In Prognosis Studies and certainty with GRADE. Six studies (416 patients) were included. Fatty pancreas was associated with a modest excess of nodal positivity (four studies, 275 patients; risk ratio 1.27, 95% CI 1.03–1.57; I² = 3%), but significance was lost when any of three studies was omitted. No statistically significant association with overall survival was identified (three studies, 268 patients; hazard ratio 1.23, 95% CI 0.64–2.38; I² = 77%). Certainty was very low for both outcomes, and these hypothesis-generating findings do not support a current clinical role.</p>